| NPI | 1104219096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMILA GILLIAM Owner 469-478-7106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 56214) |
| 251C00000X Day Training, Developmentally Disabled Services | |
| 311Z00000X Custodial Care Facility | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2015-03-17 |